A multi-centre study of the community needs of people with spinal cord injuries: the first 18 months

Abstract

Study design: Multi-centre, single cohort. Objectives: To assess the needs, perceived environmental barriers, level of participation and psychological function of spinal cord injured patients living in the community 3-18 months after discharge. Setting: The National Spinal Injuries Centre, Stoke Mandeville, UK.; Princess Royal Spinal Injuries Centre, Sheffield UK.; Midlands Centre for Spinal Injuries, Oswestry, UK. Method: Participants sustaining injury aged 18 or above were recruited from one of three spinal cord injuries units 3-18 months after discharge. Postal packs containing questionnaires, consent forms and information were distributed and a 2-week reminder was sent. Results: Main findings showed community needs to be generally well addressed however psychosocial needs were rated significantly lower than physical. Responses suggested no environmental impact on participation levels, however, qualitative data highlighted delays in accommodation, adaptations and availability of equipment to interfere with transition to community living. A substantial amount of respondents reported significant impact on independence and activity from secondary conditions and pain. Nearly all the sample reported dissatisfaction with their sexual life and these needs were not well addressed. Conclusions: Societal participation continues to be affected by secondary conditions and pain, whereas delays in equipment and structural adaptations impact on the transition to community living. Sexual needs and problems remain an issue for the spinal cord injured population and a need which is left unaddressed in the community.

Life satisfaction, appraisals and functional outcomes in spinal cord-injured people living in the community

“…This reflects the way in which goals and expectations can change over 17 and lead individuals to re evaluate internal values and standards. The current study found that life satisfaction was unaffected by physical limitations, which supports previous qualitative findings 18 in which 51% of participants report other factors as contributing to life satisfaction. The sample recruited in the current study were recruited relatively early on in the rehabilitation process, and as previously discussed, the ability for personal goals and reevaluation of priorities is such that the predictive relationships found in the current study may not be extrapolated to individuals having lived with their injury over a longer period of time.…”

Nasal Resistance Is Elevated in People with Tetraplegia and Is Reduced by Topical Sympathomimetic Administration

“…8 In acute tetraplegia, these deficits are likely to prolong rehabilitation, and in chronic tetraplegia these same deficits will reduce independence and limit vocational outcomes. 1,26 CPAP is poorly adhered to in people with tetraplegia, and as such alternative effective therapies are urgently needed. The identified, modifiable contributor to OSA of increased nasal resistance may present a therapeutic target for future research.…”

ToCUEST: a task-oriented client-centered training module to improve upper extremity skilled performance in cervical spinal cord-injured persons

“…9 Even more, SCI is a chronic illness and these patients encounter changing needs throughout their lives. 5 ToCUEST is offered as a training module.…”

“…Literature stresses the importance of using clientcentered outcome measures in the assessment of persons with tetraplegia, but also the need to develop adaptable rehabilitation programs to ensure that individual requirements are addressed. 8,9 Also, a lack of theoretical frameworks to formalize client-centered rehabilitation approaches, 8,10 a lack of guidance on how to apply goal-setting theories into clinical practice 6 and the need to obtain evidence about their efficacy are reported. 7,11 Whereas some research in SCI focuses either on clientcenteredness and goal setting or on general training programs of arm and hand, both principles are merged in the present study.…”